BUT WHY, RHABDO? Y U DO DIS 2 ME?

If you have a lot of questions about rhabdomyolysis or how a high volume athlete like myself could become injured in such a way, please read along as I try to better understand things myself. I will say this, I am content with the fact that I had rhabdo. I’ll explain that later.

What is rhabdomyolysis a.k.a. rhabdo?

The short of it is “Rhabdomyolysis is a medical condition that may arise when muscle tissue breaks down and the contents of muscle cells are released into the bloodstream. One molecule in particular, myoglobin, is toxic to the kidneys and can cause kidney failure and, in the most severe cases, death.” – Dr Michael Ray

So how does one get his or her body to the point of muscular breakdown? Basically you beat the crap out of your body! There are a number of factors that can lead to rhabdo, but in the arena of health and fitness, high intensity and/or high volume workouts usually get the blame. But is that fair?

The following is a non-comprehensive list of factors that could lead to one getting diagnosed with rhabdomyolysis

• Use of alcohol or illegal drugs such as cocaine or amphetamines
• Extreme muscle strain, especially in someone who is an untrained athlete
• Crush injury such as from an auto accident, fall, or building collapse
• Long-lasting muscle compression such as that caused by lying unconscious on a hard surface during illness or while under the influence of alcohol or medication
• Use of medications such as corticosteroids or statins, especially when given in high doses
• Electrical shock injury, lightning strike, or third-degree burn
• Very high body temperature (hyperthermia) or heat stroke
• Seizures
• Metabolic disorder such as ketoacidosis
• Disease of the muscles (myopathy) such as congenital muscle enzyme deficiency or Duchenne’s muscular dystrophy
• Viral infection such as the flu, HIV, or herpes simplex virus
• Bacterial infection leading to toxins in tissues or the bloodstream (sepsis)

When it comes to exertion induced rhabdomyolysis a trip to the ER is more likely to occur when strenuous bouts of exercise are performed under high temperatures and humidity with inadequate recovery between bouts of exercise or intense physical training. Poor hydration levels before, during, and after strenuous bouts of exercise can increase one’s risk of getting rhabdo.

So how did I get rhabdo?

First let me give you a fuller picture of who I am. I have training goals that are specific to myself that differ greatly from my clients. I am not Rich Froning or Ben Smith. I am simply me and no one else. I am trying to be better, so I might look to certain individuals to push me, but I am not on that level yet and perhaps never will be. I am however a high volume athlete and have been pushing myself ever since I was told that there was something I couldn’t do. I’ll spare you the rant here. Just understand that I have no chill. If you challenge me in a physical or mental conquest, just know that I will do everything shy of cheating to win.

To get a better picture of my training volume here are the condensed notes from a recent week of training:

Monday:

1. Warm-up with overhead movements: work up to 1 rep at 70% of my heaviest snatch weight in the heaving snatch balance + an overhead squat
2. Work up to a 1 rep max Front squat for the day with a 1 second pause at the bottom
3. Work up to a 1 rep max snatch pulling the weight from blocks at knee height
4. Work up to a 1 rep max clean pulling the weight from blocks at knee height
5. 2 sets of 3 reps snatch pulls. Start at 100% of my heaviest snatch and work up
6. 100 steps walking lunges
Tuesday:

1. Work up to a 1 rep max Front squat for the day with a 1 second pause at the bottom
2.Work up to a 1 rep max snatch without moving my feet and without using a hook grip.
3.Work up to a 1 rep max jerk with a 3 second pause in the catch
4.Met-con: For time, complete
21-15-9 reps of deadlift at 225 lbs
Run 400 meters between sets
5.Core Conditioning: Complete 3 rounds of
30 calories on the rower
30 hollow rocks
30 superman touches
6.Body building accessory work with light weights. Not moving against a clock
Dumbbell pressing, incline bench press, single arm dumbbell press, single arm kneeling rows.

Wednesday – Saturday are very similar to these two days; various styles of squatting, and olympic-style weightlifting movements all performed to a 1 rep max for the day. Wednesday and Friday morning of this particular training week, I added in a morning swim workout that was minimal in it’s volume and short in it’s intensity. During this particular week, Monday and Thursday did not include a high intensity training session.
I almost always take a complete rest from strenuous activities on Sundays and spend those days with my family; going to church, visiting relatives, doing minor household chores, or simply vegging out and napping the entire afternoon.

Like I said before, this is my training volume, not anything that I ask or push anyone else to do. Bottom line is I love what I do and will continue to see how far I can push myself.

“Okay, but you still didn’t answer why you got rhabdo and the other 50+ people that worked out with you didn’t!”

Oh, I guess I did get carried away. Sometimes I blur the lines between bragging and trying to get others to better understand me. I sometimes have a big ego. It’s not okay, and I’m working on it.

So looking at this list, what factors were common to everyone in the gym and what factors were only particular to me?

First the workout: On Memorial Day, Monday 2016, some 50+ people and myself completed various renditions of the hero workout “Murph.” The main version of the workout of which I will discuss went as follows:

Run 1 mile, then complete
100 pull-ups
200 push-ups
300 air squats
Then run another mile

The pull-ups, push-ups and squats could be broken up into smaller sets and mixed any which way as needed or desired to complete the total rep count. I recommended (and many followed) to break up the reps as such: 20 rounds of 5 pull-ups, 10 push-ups and 15 air squats. Many people did not have the pulling strength to complete the total volume of pull-ups, so I recommended that they scale the movement using ring rows. As another option, some chose to elevate their hands on a bench or other platform to take away some of their bodyweight to complete the total number of push-ups. Like I said, I have different goals and a different training background. Only one other member did the workout in the same manner as myself; unpartitioned. That means we worked straight through the list, one movement at a time (FYI: He did not get rhabdo).

So what were the broad similarities of everyone that participated?
Everyone was in the same environment: 70+ degrees with fans blowing. Some were in a state of fatigue. Some were not properly rested. Some were not properly hydrated.

What were some of the bigger differences?
Not everyone was a member of the gym and therefore most were not familiar with this type of workout volume. About half of them did this workout for the first time; whether as expressed above or cut nearly in half. There were people there who were overweight, de-conditioned, or underweight. Some even had movement restrictions and medical conditions that did not allow them to complete all of the movements to a strict standard. Others cheated…there are always cheaters!

What were some of my conditions?
Out of all participants, how is it that the guy that runs the gym and quite possibly has a training volume bigger than this on any given day put himself at risk for rhabdo? My diet is pretty full and clean. I don’t do any drugs, and have a total of about 6 bottles of beer in one year. “Don’t smoke. Don’t chew. Don’t go with girls that do!” I am free of any and all infectious diseases. I don’t have any recent impact injuries, I have not been electrocuted. I have not been laying unconscious on a hard surface for a prolonged period of time. So what’s the deal!?!

“Finally, he gets to the point…”

I was partially dehydrated Monday morning and pretty well fatigued from a weekend road trip to Columbus. It was hot, and I didn’t get a full night’s sleep the night before. None of this is really out of the ordinary for me though. As the owner and only trainer at the box, I am almost always training in a state similar to this and I’ve never gotten rhabdo before.

All of these factors most-likely contributed to my particular case of rhabdo, but none where the root cause. The main culprit was my weak grip in my right hand. How does that make a difference you ask! Well lemme esplain. I dislocated my shoulder in October of last year and as a result, damaged a great deal of nerves throughout the length of my arm from the shoulder down. Six months later, and I am still numb throughout much of my right hand. While I have a grip, it’s not very strong. I have only about 50-60% of the grip strength that was once there. This causes me to focus harder on not letting any object slip through my fingers. To better manage my grip, I often consciously and subconsciously slow down my movements to do so.

Herein lies the danger!

One of the leading causes of exertion induced rhabdo is attributed to a high volume of aggressive eccentric movements. The eccentric phase of a movement is sometimes referred to as the negative phase of the movement. Your body can control a lot more weight in the eccentric portion of a lift. Take for instance the back squat. Let’s say that I can lift 390 lbs in a back squat. I take the bar out of the rack, move down int the squat with control and safely stand the weight back up. The lowering of my body with the weight across my shoulders is called the eccentric phase of the lift. Standing up with the weight is called the concentric phase. Because I can handle more weight in the eccentric phase, I can safely add 10 more pounds to the bar and go for another attempt. In this attempt, I safely take the bar out of the rack upon my shoulders, and safely control the weight while I lower myself into a full depth squat. However while in the bottom, I find that I no longer possess the strength to stand the weight back up.

So how does my grip and the eccentric phase of a movement factor in to the workout? Like I mentioned before, I chose to complete all 100 of my pull-ups in total before moving onto my push-ups. My particular case of rhabdo was specific to my biceps and here’s why. During the pull-ups, in order to maintain a secure grip, I slowed down the eccentric portion of the movement so that I wouldn’t slide off of the pull-up bar within sets as I lowered my arms into full extension. By doing so, I was able to get the pull-ups done rather quickly and was quite pleased with myself. I didn’t notice any immediate discomforts and kept pushing along until I completed the entire workout.

The next out of the ordinary factor that contributed to my particular case of rhabdo was my lack of appropriate recovery. When I was finished, I hung out for a bit and then ran another mile to check for stragglers on the route. Once everyone left, I then chose to do some overhead squats and work up to a max effort front squat with a 2 second pause for the day. I felt great during all of this. The problem wasn’t the extra work. The problem was that I never did anything to cool down my body temperature. Instead I chose to stay in the heat of the gym and workout a bit longer. Although I did nothing more with my biceps, I was slowly but surely getting in the way of my body’s ability to heal itself. After squatting, I went to a barbecue and spent the next 4 hours in the sun, playing lawn games, swimming, and canoeing. I drank some fluids, but never did enough to lower my body temperature. Once the cookout was over, I came home and decided to mow the lawn while I had the opportunity. At the end of the night, I finally took a cold shower and went to bed. Too little too late. Rhabdo was beginning to set in the next morning. My arms grew sore and tight and by the next day, Wednesday, my arms were swollen and practically fixed in place. I went to the hospital that night and was subsequently admitted over night and then the next two until my kidney enzymes were able to return to a safe level. I am home now and will make a full recovery.

So like I said from the start, I am content with the fact that I got rhabdomyolysis. For starters, I never thought I could push myself that hard. But more importantly, I’m glad that it’s me and not you. The pain was temporary, but it helped me understand the nature of the beast and the many factors that when thrown into one setting can cause the perfect storm for inducing rhabdo.

So, did doing CrossFit give me rhabdomyolysis? In other words, is CrossFit safe?

CrossFit did not give me rhabdo. If anyone asks, I didn’t get rhabdo by doing a high intensity workout regimen. I got rhabdo by not heeding the advice that I give to all of my clients. Warm-up, cool-down, stay hydrated, rest well, and scale your movements as needed. Don’t be a hero and leave your ego at the door. I broke every last one of those rules. If I could change any one thing that I feel would’ve prevented me from getting rhabdo, it would be to either rest longer between sets of pull-ups or to simply find a way to lower my body temperature immediately after completing an hour-long workout in the heat and staying out of the heat for the rest of the day. But changing both would be a safer route.

Considering the length of this post, I will wrap it up here and leave you the links to the articles that I pulled my information from. I will be doing a separate post about the symptoms of rhabdo and how I plan to recover and work back up to my normal training volume. It will be much shorter. I promise! Please ask me questions if anything is confusing. I will attempt to clear anything up in the next post.

THE TRUTH ABOUT RHABDO: by Dr. Michael Ray
RHABDOMYOLYSIS REVISITED: by Dr. Will Wright
RHABDOMYOLYSIS – KNOW THYSELF: By Jared Moon